Why Doctors Don’t Support E-Cigarettes

By NEIL SCHACHTER, MD

This week, the federal Food and Drug Administration (FDA) announced proposed broad new rules to regulate the growing electronic cigarette industry - rules that would set limits for both the manufacture and marketing of e-cigarettes. For example, companies would have to apply to the FDA for approval of ingredients used in these products; they may not be sold to those under age 18; and sales would be prohibited in areas where minors are allowed. Manufacturers would also not be able to make claims for safety and health benefits unless they can be proven.

The proposed regulations have drawn protests from both e-cigarette manufacturers on one side and anti-smoking advocates on the other. Trade associations which represent the e-cigarette industry maintain that these regulations are extensive and time-consuming. Doctors and health care advocates feel that these regulations don't go far enough, pointing out that the FDA proposals do not deal with key issues such as the use of popular flavoring agents designed to attract children, and that the same proposals permit TV advertising, which have long been banned for traditional cigarettes.

E-cigarettes are battery-powered devices that produce a nicotine-infused vapor, which is then inhaled by the user and absorbed through the airways. These products have been promoted as a less expensive and "safer" alternative to traditional cigarettes and even as aids for smoking cessation. But manufacturers have added "flavorings" (e.g. bubble gum, chocolate and rum raisin), and as a result, the popularity of these products has soared: from 2011 to 2012, annual e-cigarette sales rose from $250 million to $500 million.

E-Cigarettes and Health Concerns
The heart and respiratory dangers of nicotine have been well documented, and health experts are right to be concerned about the potential hazards of a new nicotine delivery system. Nicotine is a highly-addictive toxin that raises the heart rate, crosses the placenta and affects the fetus, and causes changes in the airways similar to those seen in cystic fibrosis. Nicotine has been linked to different types of cancers and has been shown to alter gene expression. Because the nicotine vapors of e-cigarettes do not carry the same products of combustion as traditional tobacco, "vaping" has been heavily promoted as a safe and effective way to quit smoking. However, it is not nearly that simple, and there have been few studies - if any - which address the potential short- and long-term health effects of this drug delivery system.

In addition to personal concerns for the health of e-cigarette users, there are concerns regarding the impact for exposed non-users. (Think of the known effects of secondhand tobacco smoke on non-smokers). According to a German study, fumes from e-cigarettes, even in a well-ventilated room, increased airborne levels of carcinogenic hydrocarbons, aluminum, and nitric oxide, thereby raising the issue of the health consequences of secondhand exposures.

The Marketing of E- Cigarettes
Perhaps the most disturbing aspect of e-cigarettes is their marketing to children and teenagers. Sweetened and colored flavorings make the vapors seem more like candy than an addicting introduction to nicotine. Even the name of the product, which links it to technology (by virtue of the "e" in "e-cigarettes"), is designed to hook a new young generation on nicotine. This is why a major focus of public health representatives has been to limit marketing, and is why this first set of regulation has focused on minors. It's a welcome first step but more is needed.

The healthcare consequences of traditional cigarettes are well defined and accepted by virtually everyone, whereas those of e-cigarettes are not. The aura that has accompanied the roll-out of e-cigarettes is unsupported by scientific studies, and the absolute last thing we need is to introduce a new nicotine-based product without assurances that the mistakes of the past are not repeated.

-Neil Schachter, MD

Readers - Have you seen or tried smoking e-cigarettes? What are your thoughts on them? Did you know that second-hand fumes from these vapor pens could cause damage? Leave us a comment below and let us know what you think.

Dr. Neil Schachter is currently the Maurice Hexter Professor of Pulmonary and Community Medicine and Medical Director of Respiratory Care at Mount Sinai Medical Center. Author of five books and over 400 articles and abstracts on pulmonary disease, Dr Schachter is past President of the American Lung Association of the City of New York, the Connecticut Thoracic Society and the National Association of Medical Directors of Respiratory Care. Dr. Schachter has been an advocate for environmental lung issues such as air pollution, occupational lung disease and anti-smoking campaigns. He has lobbied extensively for tougher anti-smoking laws in New York City. He recently established and directs the Mount Sinai Pulmonary Rehabilitation program.

He is the author of "Life and Breath" (Broadway Books) a layman's guide to the latest strategies for fighting asthma, emphysema, and chronic bronchitis at any age and the recently published "Good Doctor's Guide to Colds and Flu" (Collins).

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